Is fibre good or bad for SIBO?

By pernille jensen

Is fibre good or bad for SIBO?

Small intestinal bacterial overgrowth (SIBO) is believed to affect up to 80% of individuals with irritable bowel syndrome (IBS). SIBO triggers inflammation both in the gut and throughout the body, making it a key factor in many chronic health conditions. It is also notoriously difficult to treat due to high relapse rates, so developing new treatment approaches is highly valuable.

Treating SIBO requires a comprehensive strategy, including dietary and lifestyle adjustments, addressing underlying causes, reducing symptoms, managing inflammation, and most critically, eliminating bacterial overgrowth in the small intestine.

Rifaximin is the most commonly prescribed antibiotic for SIBO. It acts locally in the small intestine, with some studies reporting efficacy rates as high as 87% for hydrogen-dominant SIBO and 85% for methane-dominant cases when combined with neomycin.

Herbal antimicrobials are also frequently used in treatment, with some research showing similar success rates to rifaximin. In one study, the combination of rifaximin with partially hydrolyzed guar gum (PHGG), a soluble fiber, was compared to rifaximin alone, assessed by a glucose breath test (GBT) and symptom questionnaire. PHGG, a low-molecular-weight fiber derived from guar gum, is water-soluble, tasteless, and easy to use in both powder and capsule form.

In this study, 500 patients with IBS-like symptoms underwent a 50g glucose breath test. Those with positive test results and risk factors for SIBO were randomly assigned to receive rifaximin 1200 mg/day alone or rifaximin 1200 mg/day with PHGG at 5g/day for 10 days. Symptoms were recorded both before treatment and one month after discontinuation.

The eradication rate of SIBO was 62.1% in the rifaximin group and 85% in the rifaximin plus PHGG group. Clinical improvement was observed in 86.9% of the rifaximin-only group and 91.1% of the combination group.

What can we learn from this as clinicians?
PHGG appears to enhance the effectiveness of rifaximin in treating SIBO. Several factors could explain this:

1. A primary cause of SIBO and its frequent relapses is damage to the migratory motor complex (MMC), which regulates gut motility between meals, helping to clear bacteria and prevent overgrowth. Disruption of the MMC, often linked to food poisoning, is a major driver of SIBO. As a soluble fiber, PHGG may help improve small intestine motility.

2. PHGG acts as a prebiotic, increasing beneficial bacteria like lactobacilli and bifidobacteria, which are often deficient in IBS patients. Since antibiotics target replicating bacteria, providing a fuel source through prebiotics may stimulate bacterial replication, making them more vulnerable to antimicrobial treatment. Without available nutrients, bacteria enter a dormant state, reducing the effectiveness of antibiotics.

Dr. Mark Pimentel, a leading SIBO expert, suggests that this study may support incorporating foods high in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) during treatment, as these foods also promote bacterial replication, increasing antibiotic efficacy.

The 2010 Funari et al. study supports the use of PHGG alongside antimicrobial treatments for SIBO. While more research is needed to confirm these findings, the use of PHGG appears safe and potentially beneficial.

 

 

References

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  3. Funari, G., Gabrielli, M., Lauritano, E. C., Scarpellini, E., Lupascu, A., Ojetti, V., & Gasbarrini, A. (2010). A randomized double-blind placebo-controlled trial of partially hydrolyzed guar gum (PHGG) in the treatment of small intestinal bacterial overgrowth. Alimentary Pharmacology & Therapeutics, 31(10), 1196-1203. doi:10.1111/j.1365-2036.2010.04290.x

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